CHOOSE ANY THREE NAIL CONDITIONS AND GIVE A REFERENCED ACCOUNT OF THEIR CAUSES(S) AND MANAGEMENT. PLEASE NOTE NOT ALL REFERENCES WILL GIVE YOU THE SAME METHOD OF MANAGEMENT AND SOME WILL GIVE MORE THAN ONE METHOD
Nail fungi (onychomycosis) is caused by dermatophytes that invade the nail matrix. They possess the ability to thrive and grow on the protein keratin and favour damp and dark conditions, therefore the human toenail and nail bed provide the ultimate breeding ground. (Johnson 1993) The most common is Trichophyton Rubrum, the same causes “athletes’ foot”. This commonly affects the sole, dorsum, lateral borders and in between toes. If left untreated, the infection can spread to the nail matrix. (Bristow I. 1996)
Fungal infections can start by trauma to the toenail which leaves it vulnerable to infection. People who do not maintain a good standard of foot hygiene are predisposed to fungal infections. Failure ...view middle of the document...
(Turner & Merriman 2005) For ongoing management diligent foot hygiene, discarding of infected footwear and continuing preventative treatment advice should be given. (Bristow I. 1996)
INGROWING TOENAILS (ONYCHOCRYPTOSIS)
The most common causes of ingrowing toenails are poor cutting technique where nails are cut too short and ill-fitting shoes. (Bristow I. et al 1996) According to Johnson, overuse of foot baths creates hyperhidrosis, moist tissue that is less resistant to pressures caused by narrow footwear or abnormal weight bearing forces.
Isolated occurrences of onychocryptosis may be resolved by conservative removal of the spicule and packing the sulcus with cotton wool. Antibiotic cover may be required depending upon the severity of the bacterial infection. Education is vital to minimise recurrence. Where the problem is recurrent, partial or total nail avulsion under local anaesthetic with phenolisation of the nail matrix is usually successful. (Bristow I. et al 1996)
Onychogryphosis is a condition seen in the great toe but in severe cases can be seen in lesser toes also. Commonly it is seen in the elderly and infirmed and is probably due to trauma, footwear pressure, neglect and can be associated with poor peripheral circulation and fungal infection. (Baran et al 2002)
Treatment of the nail involves reduction of the excessive nail using nail nippers and the nail drill taking care not to haemorrhage any skin tissue caught up in the malformed nail. Throughout treatment it is important to hold the toe firmly to avoid any excessive pulling on the underlying soft tissue. Footwear should be addressed to ensure proper fitting and the above treatment should be repeated at regular intervals. (Johnson M. 1993)
Bristow I., Dawber R., Mooney J. (1996) “The Foot: Problems in Podiatry and Dermatology”. Martin Dunitz Ltd, London
Johnson M. (1993) “Neale’s Common Foot Disorders: Diagnosis and Management”. Churchill Livingstone
Baran R., Dawber P. R., Tosti A., Haneke E. (2002) “ A Text Atlas of Nail Disorders”. Martin Dunitz Ltd, Singapore
Turner W. A., Merriman L. (2005) “Clinical Skills in Treating the Foot”. Elsevier Churchill Livingstone, China